No abstract available.

BACKGROUND: Bacteriokiller system(BKS) produces disinfectant which is generated by the mixture of active oxygen and hypochlorous acid with tap water. Previous studies showed that BKS disinfectant is highly bacteridal against clinical isolates in in vitro testings and more effective than general soap and water for the disinfecttion of contaminated handa. This study was performed to evaluate ling-trem effects of BKS as a handwasing agent in clinical settings. METHODS: Five BKS were installed for the 9-month period from June 1995 to February 1996 in 16-bed Neurosurgery Intensive Care Unit. Handwashing was frequency was observed after 1, 6, and 8 month of BKS use. Six-month incidences of nosocomial infecrion before and after BKS installation were compared to evaluate the possible effect of handwashings on nosocomial infection rates. A self-administered questionaire was used to collect data on handwashing frequency and their opinions of the BKS disinfectant at 2 and 8 months after the installation. RESULTS: Handwashing frequency of healthcare workers(HCWs) before and after patient contacts was increased from 34.1%(137/402) to 50.3%(193/384) (p<0.00001). At the same time, the 6-month nosocomial infection rate was down to 10.5%(43/411) from the pre-BKS rate of 13.0%( 51/431) and the patient-day rate was also decreased from 18.3(56/3068) to 15.1(43/2,844). Most (80.5%) of HCWs thought that BKS promote handwashing and "convenience" was the main reason for more frequent handwashing. Ninety three percent of HCWs would recommend the replacement of tne existing sinks and handwashing disinfectants with BKS. NO adverse skin reaction were reported after 8 months. Conclusions: BKS appears to promote handwashing because it is easy to use with no skin irritation and may contribute toward the prevention of nosocomial infections.
Cross Infection ; Delivery of Health Care ; Disinfectants ; Hand Disinfection ; Humans ; Hypochlorous Acid ; Incidence ; Intensive Care Units ; Neurosurgery ; Reactive Oxygen Species ; Skin ; Soaps

BACKGROUND/AIMS: The inhibitory effects of the combination of beta-lactam with ciprofloxacin or amikacin against clinical isolates of multidrug-resistant Pseudomonas aeruginosa were evaluated. METHODS: This study examined ten isolates with variable levels of resistance to ceftazidime, cefepime, piperacillin/tazobactam, meropenem, ciprofloxacin, and amikacin. The efficacy of the combined antibiotics was studied using a checkerboard method or in vitro killing assay. RESULTS: The combination of ceftazidime, cefepime, aztreonam, piperacillin-tazobactam, or meropenem with amikacin showed synergistic effects for all of the strains regardless of the minimum inhibitory concentration (MIC) of amikacin, but combination with ciprofloxacin showed a synergistic effect for the isolate with a low MIC of ciprofloxacin by the checkerboard method. The isolates with a high MIC of ciprofloxacin showed an indifferent effect in combination with beta-lactam and ciprofloxacin. The in vitro killing assay showed that meropenem with ciprofloxacin acted synergistically for the isolates with a MIC of 16 microgram/mL of ciprofloxacin. However, amikacin showed synergistic effects with meropenem for the isolates with high-level resistance against amikacin, i.e., up to an MIC of 128 microgram/mL. Contrary to the checkerboard method results, no synergy was observed for the combination of ceftazidime/piperacillin-tazobactam and amikacin. CONCLUSIONS: Meropenem with amikacin can be the first choice for infections caused by multidrug-resistant P. aeruginosa when the level of resistance is not known.
Amikacin ; Anti-Bacterial Agents ; Aztreonam ; Ceftazidime ; Cephalosporins ; Ciprofloxacin ; Homicide ; Microbial Sensitivity Tests ; Pseudomonas ; Pseudomonas aeruginosa ; Thienamycins

No abstract available.
Allopurinol* ; Animals ; Liver* ; Rats* ; Reperfusion Injury* ; Verapamil*

BACKGROUND: Over the decade, Klebsiella pneumoniae resistant to broad-spectrum oephalosporins have been involved in hospital outbreaks, particulaly in intensive care units. Betwem March 20 and June 12. 1900. an outbreak of sepsis caused by multiresistant K. pneumoniae in the neonatal intensive care unit (NICU) of Asan Medical Center. This paper describes bacteriologic, molecular and epidemiologic features of the outbreak. METHODS: For surveillance purpose, stool specimens were obtained from all patients, nurses and house staff in NICU and cultured onto MacConkey agar medium containg cefotaxim, (10 microgram/ml). All K. pneumoniae isolated blood culture isolates form patients with sepsis were tested for antobiogram by microbroth dilution method and for detection of extended-spectrum beta-Iactamase (ESBL) by double disk synergy test and ESBL Etest. Restriction profiles of total genomic DNAs were compared by pulsed filed gel electrophoresis(PFGE) after cleavage by Xbal. beta-Lactamase was tested using nitroefin disks and characterized by transconjugation to Escherichia coli and isoelectric focusing. For infection control, all infected or colonized patients and nurses were cohorted into a separate room and strict barrier precautions were enforced. RESULTS: The outbreak involved 7 patients with sepsis form whom multiresistant. K. pneumoniae were isolated. Surveillance culture revealed that 9 of 37 patients and 2 of 48 nurses and house staff were colonized. The 18 isolates showed 8 different antimicrobial resistance patterns with cefotaxime resistance in all. Test for ESBL was positive in all 18 isolates but only 15 isolates by ESBL Etest. PFGE analysis showed that 6 of the 7 blood isolate from infected patient and 9 of the 11 fecal isolates from surveillance cultures were of the identical or very similar pattern. beta-Lactamase activities were transferable by conjugation in all but one isolate. No additional case of multiresistant. K. pneumoniae infection had been reproted for 6 months since the introduction of strict barrier precautious and other infection control measures. CONCLUSION: The outbreak was caused by ESBL-producing K. pneumoniae which appeared to be introduced into the NICU from multiple sources as was indicated by PFGE patterns. An optimal laboratory method for screening for ESBL remain to be developed as the double disk synergy test and ESBL Etest did not show complete agreement. As for infoction control our results emphasize the necessity of early recognition of outbreaks, cohorting of not only infected but also colonized patients and reinforcement of the barrier precuations for the prevention of further spread of cross-infections.
Agar ; beta-Lactamases* ; Cefotaxime ; Chungcheongnam-do ; Cohort Studies ; Colon ; Cross Infection* ; Disease Outbreaks ; DNA ; Escherichia coli ; Humans ; Infant, Newborn ; Infection Control ; Intensive Care Units ; Intensive Care, Neonatal* ; Internship and Residency ; Isoelectric Focusing ; Klebsiella pneumoniae* ; Klebsiella* ; Mass Screening ; Pneumonia ; Sepsis

BACKGROUND: Despite increasing importance of Acinetobacter baumannii in nosocomial infections and rapid development of multi-antimicrobial resistance in this strain, the resistance mechanisms of beta-lactam antimicrobials in A. baumannii were not clearly defined. In order to observe the resistance mechanisms against beta-lactams and carbapenem, we characterized the production of beta-lactamases and outermembrane protein (OMP) profiles for the 44 clinical isolates of A. baumannii. METHODS: The MICs of antimicrobials were determined by agar dilution test. The secondary beta-lactamases were characterized by isoelectric focusing, polymerase chain reactions and nucleotide sequencing, and the production of chromosomal beta-lactamases was quantitated by spectrophotometric method. For two strains with an elevated MIC of carbapenem, outermembrane protein (OMP) profile was analyzed by ultracentrifugation of the sonicated bacteral cells and SDS-PAGE. RESULTS AND CONCLUSION: Twenty two or 4 of 44 strains produced TEM-1-like beta-lactamase or PER-1 extended-spectrum beta-lactamase, respectively. However, when we analyzed the MICs of several beta-lactams with the beta-lactamase production, the resistance level of beta-lactam was mainly determined by the production of chromosomal beta-lactamase, not by the secondary beta-lactamases in the clinical isolates of A. baumannii. In two strains with an elevated MIC of imipenem, a decrease or loss of about 35 kDa and 22 kDa proteins in OMP was observed, which suggested that the change of OMP played a role in carbapenem resistance.
Acinetobacter/*drug effects/isolation & purification/metabolism ; Acinetobacter Infections/drug therapy/microbiology ; Antibiotics, Lactam/*pharmacology ; Bacterial Outer Membrane Proteins/biosynthesis ; Carbapenems/pharmacology ; Cross Infection/drug therapy/microbiology ; Drug Resistance, Bacterial ; Human ; beta-Lactamases/biosynthesis

BACKGROUND: We investigated whether culture using an automated blood culture system enhances the recovery of bacteria and fungi from body fluids other than blood when compared to conventional solid media culture methods. METHODS: A total of 734 specimens [ascites (n=457), bile (n=5), CAPD (n=28), CSF (n=32), joint fluids (n=165), pericardial fluid (n=17), and pleural fluid (n=30)] were included in the study. Half of the volume of each specimen was inoculated directly into automated blood culture bottles (bioMeriux, Marcy-I'Etoile, France). The remaining volume was inoculated onto conventional solid media (sheep blood agar, chocolate agar, and phenylethyl alcohol agar) after centrifuging at 3,000 rpm for 10 min. RESULTS: Clinically significant microorganisms were isolated from 62 specimens (8.5%) by automated blood culture and 61 specimens (8.3%) by the conventional solid media culture (kappa index: 0.81, 95% confidence interval: 0.75~0.89). Contamination was observed in 11 (1.8%) of the automated blood culture specimens and 3 (0.4%) of the solid media culture specimens. The mean turnaround times of the automated blood cultures and the conventional solid media cultures were 3.7 and 2.8 days, respectively (P<0.0001). CONCLUSION: Compared with conventional culture methods, no improvement in the recovery of clinically significant microorganisms was noted with the use of the automated blood culture system for the culture of body fluids other than blood.
Agar ; Bacteria ; Bile ; Body Fluids ; Cacao ; Fungi ; Joints ; Peritoneal Dialysis, Continuous Ambulatory ; Phenylethyl Alcohol

No abstract available.
Acute Kidney Injury* ; Hepatitis* ; Humans ; Oxidoreductases*

Azithromycin* ; Doxycycline* ; Scrub Typhus*

No abstract available.
Scrub Typhus* ; Seoul*